A 48-year-old woman with autoimmune hepatitis on azathioprine 100 mg/day and prednisolone 5 mg/day has been in histological remission for 3 years. She requests withdrawal of therapy. What is the major risk on drug withdrawal and how should it be managed?
- A Cirrhosis development within 6 months if drugs are stopped regardless of remission
- B No relapse risk after 3 years of remission; drugs can be stopped immediately
- C Relapse risk ~50–80%; requires liver biopsy confirming remission before withdrawal, then slow taper over ≥6 months ✓
- D Relapse risk <5%; biopsy not required; abrupt cessation is safe
Correct answer: C. Relapse risk ~50–80%; requires liver biopsy confirming remission before withdrawal, then slow taper over ≥6 months
Explanation
The relapse rate in autoimmune hepatitis after immunosuppression withdrawal is approximately 50–80%. Current EASL 2019 guidelines recommend attempting withdrawal only after at least 2 years of complete biochemical remission AND a liver biopsy confirming absence of interface hepatitis. Drugs should be tapered slowly. Patients with cirrhosis at presentation should generally not have treatment withdrawn.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.